rocuronium and Pharyngitis

Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty-four patients undergoing elective laryngeal micro-surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg

Topics: Adult; Aged; Anesthesia Recovery Period; Anesthesia, General; Attitude of Health Personnel; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Intubation, Intratracheal; Laryngoscopy; Larynx; Male; Microsurgery; Middle Aged; Neostigmine; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pharyngitis; Postoperative Complications; Rocuronium; Sugammadex

We evaluated the effect of magnesium sulfate-an enhancer of neuromuscular blockade-on onset and duration of low dose of rocuronium, and on operating conditions during laryngeal microsurgery.. Randomized, prospective, double-blinded study.. Eighty-four patients scheduled for elective laryngeal microsurgery.. Patients were randomly allocated to receive different doses of rocuronium: 0.6 mg/kg (group C, n=28), 0.45 mg/kg (group LR, n=28), or 0.45 mg/kg plus magnesium sulfate 30 mg/kg (group LM, n=28).. We measured the onset time and duration of action of rocuronium, and evaluated the surgeon's satisfaction with the operating conditions.. Group LR showed significantly delayed onset time (group C: 87±22 seconds, group LR: 127±47 seconds, and group LM: 89±32 seconds; P=.001) and maximal suppression than did other groups (group C: 102±30 seconds, group LR: 155±66 seconds, and group LM: 105±36 seconds; P=.002). Duration of action of rocuronium was significantly longer in group C than in other groups (group C: 39±7 minutes, group LR: 28±8 minutes, group LRM: 31±8 minutes; P<.001). Laryngoscope placement score (P=.002), surgeon's satisfaction (P=.005), and sore throat (P=.035) were significantly worse in group LR.. Magnesium sulfate 30 mg/kg accelerated the onset and improved operating conditions of low-dose rocuronium without prolongation of action.

Topics: Adult; Aged; Androstanols; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Synergism; Humans; Intubation, Intratracheal; Laryngoscopy; Larynx; Magnesium Sulfate; Microsurgery; Middle Aged; Neuromuscular Blockade; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pharyngitis; Rocuronium; Young Adult

This study investigated the hypothesis that the efficacy of insertion of the supraglottic device i-gel(®) (i-gel) can be improved by laryngoscopy and can provide better sealing pressure in anesthetized patients by novice doctors.. Eighty-four adult patients were assigned to the laryngoscopy group (L group, 42 patients) or control group (i.e., conventional blind insertion; C group, 42 patients). Anesthesia was induced with propofol and remifentanil, and rocuronium 0.6-0.9 mg/kg was administered. The number of attempts until successful insertion, sealing pressure, vital sign changes upon insertion, and subjective difficulty of insertion by novice doctors were compared between the groups.. The total number of insertion attempts was one (L group 36 cases, C group 23 cases), two (L group 6 cases, C group 18 cases), and three (L group 0 case, C group 1 case), with significant differences between groups (P = 0.007). The sealing pressure was significantly higher in the L group than in the C group (L group 22.3 ± 2.6 cmH2O, C group 19.5 ± 2.7 cmH2O, P < 0.001). Vital sign changes (heart rate and blood pressure) did not differ between the two groups. The subjective difficulty of insertion was significantly lower in the L group than in the C group (L group 26.8 ± 11.8 mm, C group 47.0 ± 15.1 mm, P < 0.001). The incidence of postoperative pharyngeal pain was significantly lower in the L group than in the C group (P < 0.001), while the incidence of hoarseness did not differ between the two groups (P = 1.00).. Our results suggest that laryngoscopy facilitates i-gel insertion by novice doctors, as reflected in the rate of successful insertions, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.

Topics: Aged; Androstanols; Anesthesia, General; Blood Pressure; Female; Heart Rate; Humans; Laryngoscopy; Male; Middle Aged; Pharyngitis; Pressure; Propofol; Prospective Studies; Rocuronium

To test the hypothesis that muscle relaxant is not necessary in patients who are undergoing laparoscopic gynecological surgery with a ProSeal Laryngeal Mask Airway (ProSeal LMA™).. Prospective, randomized study.. Operating room of Sichuan Provincial Hospital for Women and Children.. 120 adult, ASA physical status 1 and 2 women, aged 18 to 55 years.. Patients were randomly assigned to two groups (n=60) to receive a muscle relaxant (Group MR) or not (Group NMR). General anesthesia was used in patients of both groups for airway management with the ProSeal LMA. Peak airway inflation pressures, airway sealing pressure, minimum flow rate, and recovery time were assessed. Surgical conditions were assessed by the operating gynecologist. The frequency of sore throats was recorded.. ProSeal LMA insertion was 100% successful. Patients' lungs were ventilated with a maximum sealing pressure of 32 ± 5.1 cm H(2)O (Group MR) or 31 ± 4.9 cm H(2)O (Group NMR) (P = 0.341). The seal quality in both groups permitted the use of low flows: 485 ± 291 mL/min in Group MR and 539 ± 344 mL/min in Group NMR (P = 0.2). Surgical conditions were comparable between the two groups. There was no difference in the frequency of sore throats (20% vs 21.7%; P = 0.28). In Group NMR, there was a statistically significant reduction in recovery time versus Group MR (4.5 ± 2.6 min vs 10.3 ± 4.2 min; P < 0.01).. Muscle relaxant is not necessary in general anesthesia with a ProSeal LMA.

Topics: Adolescent; Adult; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Laryngeal Masks; Middle Aged; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Pharyngitis; Positive-Pressure Respiration; Prospective Studies; Rocuronium; Unnecessary Procedures; Young Adult

Muscle relaxants facilitate tracheal intubation, but they are often not used for short peripheral surgical procedures. The consequences of this practice on the upper airway are still a matter of controversy. We therefore compared the incidence of post-intubation symptoms in a randomized study comparing patients intubated with or without the use of a muscle relaxant.. A total of 300 adult patients requiring tracheal intubation for scheduled peripheral surgery were randomly assigned in a double-blind study to an anaesthetic protocol that either included or did not include a muscle relaxant (rocuronium). The primary end-point was the rate of post-intubation symptoms 2 and 24 h after extubation. The secondary end-points were the intubation conditions score (Copenhagen Consensus Conference), the rate of difficult intubations (Intubation Difficulty Scale), and the incidence of adverse haemodynamic events.. Post-intubation symptoms were more frequent in patients intubated without the use of a muscle relaxant, whether 2 h (57% vs 43% of patients; P < 0.05) or 24 h (38% vs 26% of patients; P < 0.05) after extubation. Intubation conditions were better when the muscle relaxant was used. In patients intubated without a muscle relaxant, difficult intubation was more common (12% vs 1%; P < 0.05), as were arterial hypotension or bradycardia requiring treatment (12% vs 3% of patients; P < 0.05).. The use of a muscle relaxant for tracheal intubation diminishes the incidence of adverse postoperative upper airway symptoms, results in better tracheal intubation conditions, and reduces the rate of adverse haemodynamic events.

Topics: Adolescent; Adult; Aged; Androstanols; Blood Pressure; Double-Blind Method; Female; Heart Rate; Humans; Intubation, Intratracheal; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Pharyngitis; Postoperative Complications; Prospective Studies; Rocuronium